Provider Demographics
NPI:1205910387
Name:PIERCE, DARYL THOMAS (DMD)
Entity type:Individual
Prefix:DR
First Name:DARYL
Middle Name:THOMAS
Last Name:PIERCE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4626 BUFFALO ROAD
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16510
Mailing Address - Country:US
Mailing Address - Phone:814-897-1277
Mailing Address - Fax:814-897-1492
Practice Address - Street 1:4626 BUFFALO ROAD
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16510
Practice Address - Country:US
Practice Address - Phone:814-897-1277
Practice Address - Fax:814-897-1492
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS025894L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist